This presentation was part of a joint presentation with Dr. William Wiener for a panel session titled
"Traditional and Progressive Approaches to Independent Cane Travel" at the
National Conference for Residential Training Centers for the Blind, Albuquerque, Nov. 13, 2002
See full article published in the Proceedings of the conference.
Another panel presentation on a similar topic was given in 2007, see "Traditional" O&M ...

Teaching Use of Visual and Non-Visual Techniques

The "traditional approach" of O&M programs was to teach clients to use non-visual techniques, using blindfolds for clients who have some vision. O&M programs were first developed in the 1940's for young soldiers who were suddenly, completely, and permanently blinded. These programs were anything but route travel -- the soldiers went home and traveled independently in their own communities, using only non-visual techniques that they had learned at the center in Hines, Illinois and transferred to their home environments.

In fact, all the O&M techniques that were taught were non-visual for the first several decades of our profession, even while this traditional core O&M program was adapted to serve children, elderly people, and people with multiple disabilities. Blindfolds were used extensively to help these people learn non-visual techniques, because we only knew how to teach people who were totally blind.

It was not until the mid-60's and early 1970's that some of the more progressive O&M specialists started to question the tradition and develop programs to teach people to use both visual and non-visual information and techniques to travel efficiently. These programs were resisted by the majority of O&M specialists, and so another decade passed before these innovative programs were published to any extent and started to become accepted as best practice.

So the "progressive" approach, which was developed slowly over the last half century, is to teach people to use both their vision and non-visual techniques effectively to travel.

So let's look at the challenges for people with functional vision. These people must learn:
1. non-visual techniques and how to trust the non-visual information;
2. how to use vision reliably and efficiently, while
3. not allowing vision to distract them from effective non-visual information; and
4. how to use non-visual and visual information together.

I'll go through these one by one:

Learning to use vision reliably and efficiently:

It's been written that clients who have impaired vision just naturally know how to use that vision efficiently, but that's not true.
For one thing, people must learn how much of their vision can be used reliably, and also learn the limits of their vision -- that is, when they can not rely on visual information, or when they can get the information much more effectively using non-visual techniques. Many people must also learn how to process the visual information, for example to identify objects and their implications for travel. Visual aids can be very effective for getting certain visual information but again, people need to learn how to use them effectively.

And some people need to learn to use their vision for maximum efficiently. For example people with central scotomas, such as macular degeneration, need to change a lifetime of habit to use their best point of fixation, using eccentric viewing. For example, one day I was walking with a woman with macular degeneration to an intersection and I asked her if she could see the signal. She looked and said, "No, I can't see the light -- wait! Yes, I can see the light -- oh, no, I can't see the light -- yes! I can see the light!" I realized that she hadn't learned that if she wants to see something, she shouldn't try to look at it or it will disappear, which is why she reported she couldn't see it, but when she looked away from it, she could see it again. She needed to learn to look just to the side of whatever she wants to see, after determining where is her best point of fixation.

People with peripheral visual loss, such as retinitis pigmentosa, need to learn scanning techniques. For example, when their visual field becomes less than about 5 degrees they also need to learn to change their lifetime habits, and scan at a certain speed or they will miss seeing large objects. I realized the importance of this one day when my client who is deaf and has retinitis pigmentosa looked very carefully both ways and saw no cars, and then almost walked right into a speeding car that she hadn't seen because she looked too quickly. I developed a 20-minute procedure for teaching these people exactly how to scan so they don't miss any cars [see "Scanning for Cars].

And people who can see the cars consistently sometimes misjudge how close and how fast those cars are approaching -- I believe this was the reason that a visually impaired colleague and her husband were killed crossing a street in Maryland about 15 years ago, and as a result there is now a simple procedure for teaching people to accurately judge visually when there is a sufficient gap in traffic.

So methods have been developed to teach people how to scan, how to find the best point of fixation and view eccentrally, how to visually determine whether there is a gap in traffic, how to use visual aids to get information efficiently, and many other skills.
And it's important to note that 1) these skills don't take long to teach, and 2) the instructor does not need to be sighted to teach these skills -- these teaching methods can be readily adapted, or some of them can be used as is, by cane instructors who are blind.

Learning non-visual techniques:

I think everyone knows that people can learn to notice and use non-visual information when they have lots of experiences where visual information isn't available, such as with blindfolds or real-life situations where the client cannot see well. Blindfolds are a very effective way to teach non-visual techniques. And why are blindfolds so effective? Because with a blindfold, there is no distraction from vision, so it is easier for people to notice and use the non-visual information.

Real-life situations where people cannot see well are also effective. For example night travel is a great way for people with retinitis pigmentosa to learn to use non-visual information. Many of my clients say that these real-life situations are essential -- blindfolds don't really simulate the situation in which they find themselves because lights at night can not only be useful, they can also be distracting and misleading, so the clients want to apply their skills and practice not only with a blindfold, but also in realistic conditions where they encounter challenges that are not present when they are blindfolded.

Now, contrary to what some people believe, blindfolding and night travel aren't the only ways that people can learn non-visual techniques. I've heard several times at this conference that if you don't use a blindfold, people will never learn to use non-visual information, and I'm here to tell you it's not true. People can also learn non-visual techniques if the instructor prompts them to notice and use non-visual information while they travel normally. I use this technique predominantly with some of my clients, and with some I predominantly use the blindfold, depending on the client's needs.

For example, I once started working with a middle-aged man who had been visually impaired all his life. We approached the building where we were going to begin training, and I asked him to ring the doorbell. He put his face inches from where the button was and took about 3 minutes before he finally found it and then reached for it. I then asked him to step back and scan the wall with his hand, and he found it very quickly. The next day -- and every day from then on -- he matter-of-factly approached the door and found the button by scanning with his hand, as if he had always done it that way, and he never again pressed his face up to the door to find it visually.

Another example is when a woman was on her first lesson outside, walking along a sidewalk when suddenly she saw that the sidewalk seemed to end. She got very disconcerted and asked if she was at the corner yet, and where did the sidewalk go? I asked her to relax and listen to the cars, and she then noticed that they stopped at the corner about half a block ahead. She asked what happened to the sidewalk, and I encouraged her to think about how she could find out, and after a few moments of thinking, she probed with her cane. She found that it had turned toward the building, and she continued on her way.

This is one of the biggest challenges for the client as well as for the instructor, but it can be taught using partial occlusion and intermittent occlusion.

With partial occlusion, you cover the bottom half of the person's vision so that they can't see what's on the ground in front of them, and they must rely completely on the non-visual information that the cane provides while, at the same time, they are looking around and getting information visually. This isn't easy to do, but it's an important part of real-life travel, and I have found partial occlusion to be extremely effective at enabling people to notice and use their cane information at the same time that they notice and use visual information.

With intermittent occlusion, the clients perform tasks visually, then repeat with a blindfold, then repeat the task again without the blindfold while using the non-visual information that they had noticed with the blindfold on.

For example sometimes after my clients have learned to use and trust the cane and I ask them to go outside and find the curb, they will approach the curb but pull the cane back and strain to look down and find the edge, walking very cautiously. I let them struggle and find the curb, then I ask them to come back and approach the curb again, but this time find the curb with a blindfold. They do so as efficiently as they had done similar tasks earlier in their training. Then we come back again, take the blindfold off and approach the curb, but this time consciously keep their eyes on something across the street while letting the cane find the curb as quickly as they had with the blindfold. Most clients only need to do this once or twice before they stop searching visually for the curb, and approach it confidently using non-visual information from the cane.

Again, these techniques -- partial occlusion and intermittent occlusion -- can be used by instructors who are blind as well as sighted.

Learning not to allow vision to distract from non-visual information:

Do you remember that I said that the reason that using a blindfold for training is so effective is that it prevents clients from being distracted, so they are free to notice the non-visual information? Well, when the blindfold comes off, many people will revert right back to their old habits, and let the vision interfere with their ability to notice and use the non-visual information. Thus, no program is complete unless the client learns to notice and use the non-visual information when the blindfold comes off.

Effective strategies to help the client learn to do this are, again, partial occlusion, and by having the client perform tasks where sufficient information isn't available visually, with prompting to notice non-visual information if needed.

For example, one of my clients had all her training with a blindfold and after she had become proficient and very confident with a cane, she had her first lesson with the blindfold off. She approached some stairs with her cane and saw some wires hanging over the stairs. She panicked, and almost literally got onto her hands and knees to see those wires and crawl up the stairs, but it wasn't enough -- she still couldn't see the wires clearly even when she was doubled over. I stopped her, had her relax and calm down, and told her she could get all that information with the cane, just as she had when she was blindfolded. With prompting and encouragement, she stood up and probed with the cane, found clear spaces and went up the stairs, trusting her cane to tell her where to step.

All that training with the blindfold hadn't prepared her to ignore the ineffective vision and use the more reliable non-visual information. This needed to be taught to her by practicing without a blindfold.

No program teaching independent cane travel can be considered complete for people with functional vision unless they have learned to master these four challenges -- using their vision efficiently and understanding when it's more effective to use non-visual information, noticing and using non-visual information and trusting that information, using the vision and non-visual information together, and not letting their vision distract them from using the non-visual information.